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The structure of your dissertation Your dissertation is most likely to be analytical in nature order lamisil 250 mg free shipping fungus facts. Use it to demon­ strate your in-depth understanding of the subject matter and your ability to analyse and evaluate the information order lamisil with a visa quercetin antifungal. The structure of your essay will be based on the keywords used in your title purchase lamisil australia fungus gnat trap. What do you want to achieve with your work (for example, ‘to explore x’, ‘to evaluate y’ or ‘to analyse z’)? For example: A discussion about the limitations of current infection control measures in reducing the incidence of MRSA. The key words are ‘discussion’, ‘limitations’, ‘current infection control measures’, ‘reducing the incidence’ and ‘MRSA’. The themes are: DISSERTATIONS 197 ° infection control measures ° MRSA (incidence of) ° the relationship between infection control and the incidence of MRSA. The essay will examine the evidence for the effectiveness of infection con­ trol in reducing MRSA. Breaking the essay down into its component parts in this way will help you organise information into a logical sequence. The use of headings is probably advisable considering the length of a dissertation. For example, a section from the above essay might be headed ‘The incidence of methicillin resistant Staphyloccus aureus’. He or she will be able to sup­ port your studies and advise on the writing up of your project. References A dissertation is a reflection of the broad and in-depth reading you have undertaken during your enquiry. They will help distinguish your original thoughts and ideas from those of other researchers. The nature of these ref­ erences will also give an indication of whether the information you have used is current or not and the validity of your source material. Supplying a complete and comprehensive reference list will enable the reader to follow up sources for themselves. There are two main styles of referencing: ° the Harvard style ° the Vancouver style. The Harvard style The Harvard or ‘author–date’ system is well known and widely used within academic institutions. For books, the name of the author and the year of publication are placed in parentheses within the main body of the text, for example: 198 WRITING SKILLS IN PRACTICE Use question stems (Polit and Hungler 1995) to help define your enquiry. However, if there is more than one edition of the book then use the date of the revision or edition you are us­ ing.

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Conclusion If your physician is among those who do not believe that diseases such as fibromyalgia or sleep disorders exist and you believe you have the symptoms order lamisil 250 mg line antifungal medication for ringworm, find another physician to consult order lamisil 250mg without a prescription fungus gnats dish soap. Do a thorough Eight Step analysis discount lamisil 250mg free shipping fungus gnats yellow leaves, mak- ing sure to address these specific questions: • Is your skin painful and tender, or do you feel pain all over your body, even to the point of jumping when touched? Do you hardly ever feel refreshed on wakening after a night’s sleep or even after a nap (although pain will rarely wake you)? If you answered yes to at least five of these questions, ask your doctor to investigate whether you are suffering from fibromyalgia. Also, consider whether a sleep disorder may be the underlying cause of your symptoms even if it is not fibromyalgia. Remember, sleep disorders are one of the most commonly missed causes of mystery maladies. Treatments that are supposed to make us healthier or keep us well sometimes do just the opposite. More often than many of us realize, med- ications or natural remedies recommended for the treatment of certain ail- ments can become the cause of other maladies. Recent statistics show that reactions to medications and other remedies are the fourth leading cause of death in the United States, dwarfing the number of deaths caused by auto- mobile accidents, AIDS, alcohol and illicit drug abuse, infectious diseases, diabetes, and murder. With 46 percent of Americans taking at least one pre- scription drug daily, 25 percent taking multiple prescriptions, and untold percentages ingesting over-the-counter products, there is a lot of potential for close encounters of an adverse kind. There is no formal system for reporting the majority of such reactions because side effects or adverse reactions reportable to health regulatory agen- cies are narrowly defined as clear-cut responses that cause permanent dis- ability, hospitalization, or death. Even the Food and Drug Administration (FDA) admits that serious side effects or medication reactions are grossly underreported and may be reaching epidemic proportions. Just because they are purchased from a health food store or their source is natural, it does not mean they may not be toxic for some people. Nutritional healing is becoming more 103 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum. There is much evi- dence to suggest that increasing numbers of yet unidentified maladies are resulting from nutritional supplements, vitamins and herbs, and many nat- ural remedies. These remedies must be examined because very few controlled studies are performed on them. As a result of all of these factors, it can take years (if ever) for a drug, vaccine, or natural supplement to be removed from the market as unsafe. Consider Propulsid, once the top-selling heartburn medication, which was on the market for seven years before the FDA finally withdrew it based on reports of hundreds of heart arrhythmias and scores of deaths. Or the very popular antihistamine Seldane, which sold for a decade before it was removed from the market, even though cardiac toxicities had been identi- fied and exposed years before. Many patients who were using these med- ications and experiencing mysterious symptoms had no way of connecting one with the other—especially if their physicians had no knowledge of the possible side effects. Incorrect dosing has proved to be another major cause of mysterious symptoms.

You can appreciate the light that streams in through your window at mid- day purchase 250 mg lamisil with mastercard antifungal dog food, the nurturing you receive from a caregiver purchase lamisil 250mg otc fungus gnats rubbing alcohol, the music that soothes your spirit buy generic lamisil pills fungus yellow toenail, or the television show that makes you laugh and distracts you from your illness. Enjoy the silence and stillness of the room, the comfort of the clock ticking. Take a deep breath, fill your lungs, and appreciate the air that fills them. Expressing your grati- tude creates a sense of loving and being loved, which is also essential to the nurturance of the spirit. It has an energy all its own, and it creates an invis- ible thread that binds us to the universe around us. Grace Just like faith, grace means different things to different people. To me, grace is forgiveness and compassion given to others, if for no other reason than because it was given to me. Maybe we are born with grace, but sometimes we lose it until it is awakened in us—often by something like a mystery malady. Grace is the divine help I didn’t deserve, which in turn makes me think that if I received it, the uni- verse felt I was worthy. Just as I may have had reasons for what I did that may have hurt others, so perhaps they had rea- sons for the things they did to hurt me. Part of compassion is the granting of forgiveness, and it is grace not only for them but for me. The ability to let go of my own past mistakes and allow others to do the same is grace. Carrying around self-righteousness and resentments over being wronged is too big a burden, especially if we want to get well. When we for- give, we can practically feel the tension and weight lift from our body and 238 Living with Your Mystery Malady soul. My father seemed to have found grace for both himself and others through his humor. He probably wouldn’t have admitted it, since he would have wanted everyone to believe he died the cynic he always was. But at some point toward the end of his days, his cynicism seemed to have left him. Just when you would think his fear would have been greatest, he seemed to have let go of the fears that were always present in the earlier days of his life. In his last days in the cancer ward—a pretty grim place—as he lay in his bed, every nurse and doctor who visited him left his room laughing. By laughing in the face of death and sharing his laughter with others, it was almost as if he were lift- ing everyone else’s burdens with his humor and thus lifting his own as well. He passed away soon afterward, but I would like to believe he went out of this world with grace and a sense of well-being in his spirit.

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Evaluation: some definitions and principles Evaluation is a process of obtaining information for judgement and decision making about programmes discount lamisil 250mg visa fungal watch, courses and teachers order lamisil overnight delivery antifungal rinse for laundry. Assessment cheap 250mg lamisil mastercard antifungal used in cell culture, a term which is sometimes used interchangeably with evaluation, is about obtaining information for judgement and decision making 189 about students and their learning. However, the results of an assessment of student learning is a very important part of evaluation. We are sure you will be familiar with some of the ways commonly used to gather information – questionnaires and interviews for teaching evaluations, and assignments and examinations to assess student learning. Strategies for judgement and decision-making are less well-developed, however, and we will look at these later in the chapter. This is intended to assist in change, development and improve- ment of teaching. This is used to make decisions such as whether to promote or re-appoint a teacher. Whatever the intentions of an evaluation, you will find it useful to keep in mind that there are several sources of evaluative information and methods you can use to get this information. For example, if you are particularly interested in the students’ experience, you may decide to use several different methods including diaries, ques- tionnaires and focus groups. Space does not allow us to explore all of these sources and methods, which of course can be used in a wide range of combinations. For more help, we recommend you consult someone in your institution’s teaching unit or review the references provided at the end of the chapter. However, in deciding among the options in the table, you need to be aware that two fundamental characteristics of evaluation are validity and reliability. Other important characteristics are the practicality of an evaluation and, of course, its acceptability to all those involved. Validity refers to the truthfulness and appropriateness of information provided as evidence of learning and teaching. For example, high levels of student achievement may not be a valid indicator of teaching competence because of the problem of identifying the relative contribution of teacher, student effort, library resources, students’ peers, and so on. Students can provide valid feedback on the availability of resources and teacher behavior, for example, because they observe and experience these things as part of their course. For example, information about a teacher based on the results of just one student survey will not be as reliable as information derived from several surveys conducted over several years and from a representative range of classes taught. The reliability of an evaluation may also be enhanced if different, but valid methods, are used in combination. Now, armed with this background knowledge, how might you go about evaluating your teaching? Planning evaluation as part of your teaching Among the things you need to think about are the following: Determine what are your institution’s formal require- ments for evaluation. For example, is there a requirement that you should gather student feedback on a regular basis for curriculum development or for promotion or tenure?

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While it is virtually always possible to maintain life with tracheostomy buy genuine lamisil fungus lawn, assisted ventilation and assisted tube feedings cheap lamisil 250 mg antifungal review, most will never emerge from a state of complete dependence buy 250mg lamisil visa fungal wart. For some, even yes=no binary forms of communication are difficult or impossible. The burdens of care include 194 Crawford Therapy for Spinal Muscular Atrophy 195 196 Crawford continuous high stress to other family members, limited interest or ability of some medical communities, very high financial costs borne by private and governmental third parties and families, and inevitable patient discomforts associated with the high levels of intervention necessary. For many dedicated and caring parents, these burdens easily surpass the benefit of extending life in the state of complete or near complete immobility for their children. As SMA manifests across a continuous spectrum of severity, and because every family and community will value elements of burden and benefit differently in making decisions about the goals of care, there will inevitably be many difficult cases. In recent years, advancements in ‘‘noninva- sive’’ chronic ventilation have made life somewhat less burdensome for many patients and their families, increasing the number of very weak infants for whom a decision to extend life, rather than enter into a program of palliative care, may be a reasonable choice. Caring physicians have an important role in identifying the probable conse- quences of each choice, and to help shoulder the inevitable guilt that accompanies any choice made. A choice for pure palliative care for infants with type 1 SMA is extraordinarily difficult for parents. This can be made easier by understanding that most or all of the discomforts associated with SMA 1 can be effectively minimized. Many infants develop difficulty with sucking and swallowing, particularly when during respiratory illness. In anticipation of this time, it is reasonable to place G tubes prospectively at a time when anesthesia concerns can be minimized. Local institutions favor endo- scopic or surgical approaches, and general vs. Nissen fundiplication is rarely indicated for patients receiving palliative care. Infants also tolerate thin flexible NG tubes well, which can be placed for days or a few weeks at a time in those infants who cannot tolerate G tube placement. Placement of these artificial means for alimentation do not preclude bottle or even breast feeding for those infants who are able to do so, but alleviate the difficulties with maintaining minimum caloric support that frequently develop over time. This is partially related to an increased risk of aspiration, but is less frequent than might be expected. Oral suctioning is uncomfortable for the infant; with time parents can learn to dis- tinguish noisy breathing from distressed states that are relieved with suctioning by a portable suction machine or bulb syringes. Postural drainage with a small percussive cup, or vibration, placing the most atelectatic lung segments upward can be helpful. Glycopyrrolate (Robinul) is difficult to use well; often the benefit of drying secretions is undermined by increased thickness of secretion that makes the overall situation worse. Infants often benefit from aerosolized bronchodilator treatments during times of increased respiratory distress. Many infants with SMA 1 are more comfortable and breath more slowly and effectively in a Trendelenberg position and on their side or even prone.

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